Mail to: Department of Natural Resources Captive Wild Animal Farm Captive Wildlife - CS/1 License Application PO Box 7924 Madison, WI 53707-7924 dnr.wi.gov Consult the attached instructions before completing Notice: Pursuant to ch. 169, Wis. Stats., and ch. NR 16, Wis. Adm. Code, Fees: completion of this form is required to apply for a captive wild animal farm license. Class A Captive Wild Animal Farm Operation of a captive wild animal farm without a license may result in forfeitures (Annual sales of $10,000 or more) of up to $500 in addition to suspension of eligibility for future licenses. A social $200 Initial license $100 Annual renewal security number or federal employer identification number is REQUIRED when applying for licenses according to ss. 169.34 and 169.35, Wis. Stats., but it may Class B Captive Wild Animal Farm not be disclosed by the Department of Natural Resources (DNR) to anyone (Annual sales less than $10,000) except the Departments of Children and Families, Workforce Development or the $50 Initial license $ 25 Annual renewal Department of Revenue. Personal information collected may be used for participation in surveys, eligibility for approvals, law enforcement and other $ 0 Sport Club or 4-H member under age 14. secondary purposes and may be provided to requesters to the extent required by Attach proof of current membership Wisconsin's Open Records laws (ss. 19.31-19.39, Wis. Stats.). + $20 Late fee if application filed after license expiration date. A. Applicant Information Last Name First MI DNR Customer ID Current License # (if renewal) Address Date of Birth (mm/dd/yyyy) SSN OR FEIN City State ZIP Code Daytime Phone (incl. area code) Alternate Phone # or FAX Business Name (if applicable) Email Mailing Address City State ZIP Code If Lessee, name of Property Owner I Hereby Certify that I am the: Owner Lessee If lessee, MUST include copy of lease. B. Animal Species Information Indicate below, the species of animals for which you would like to be licensed. The captive wild animal farm license is for animals in PENS ONLY. Harmful Wild Animal If applying to hold a harmful wild animal you must also complete the respective form (listed) for each species of animal held. Family Anatidae (Mute Swan) - form 9400-577A Family Felidae (Cougar) - form 9400-577C Family Ursidae (Bear) - form 9400-577B Family Canidae (Wolf-dog Hybrid) - form 9400-577D Other Species of Native Wild Animals Family Mustelidae (Mink, Otter, Badger) Family Felidae (Bobcat, Lynx) Family Canidae (Coyote, Fox, Wolf) Amphibians and Reptiles (must apply for a class A license for these species if you Waterfowl for which you possess a USFWS intend to sell any native species or possess more than 5 leopard frogs, tiger permit to possess. salamanders or mud puppies) Other species (mammals and birds), List all that apply: C. Animal Species Location Indicate the actual address where the animals are located below. Do you plan to Exhibit? include additional sheets if needed and be as specific as possible. Yes No If Yes, complete the following information Property Street Address Exhibit Street Address City State ZIP Code County City State ZIP Code County Section Township Range Section Township Range E City Town Village E City Town Village N W of N W of D. Certification I hereby certify that the above information is true and correct. I understand that providing incorrect information may result in revocation of my license and possible penalties. Signature of Applicant Date Signed If Applicant is less than 18 years of age, Signature of Parent or Guardian Date Signed Captive Wild Animal Farm License Application Please read these instructions before completing this application. The following information is provided to assist you in determining which class of Captive Wild Animal Farm License you require and in completing the application. This document does not contain a complete set of Wisconsin's laws applicable to captive wild animal farms. For complete listing of Wisconsin's laws pertaining to captive wild animal farms and licenses, consult ch. 169, Stats., and ch. NR 16, Wis. Adm. Code. Captive Wild Animal Farm Regulations, PUB-CS-17, is a summary of Wisconsin's captive wild animal farm laws and regulations. It is available online at dnr.wi.gov, keyword search "captive". Captive Wild Animal Farm License (CWAFL) – General Information A CWAFL authorizes the holder to possess, propagate, kill, exhibit, purchase and sell live captive wild animals of the species specified by the department on the license. A captive wild animal farm license does NOT authorize taking, capturing or killing animals from the wild, or the possession, care or rehabilitation of orphaned or injured wild animals. All captive wild animals must be obtained from a legal captive source. Captive wild animals can be killed only by the holder of the license or an employee of the holder of the license. The licensee may only sell live animals of the species listed on the license and only to persons authorized to possess these species. • This license is for captive wild animals confined to PENS. It is not issued for open, unenclosed acreage and does not authorize hunting or dog training. The location of the facility(s) must be specified on the application. • This license is required to possess native wild animals; non-native wild ducks, geese, brant or swans; non-native wild animals that are harmful wild animals (all bear, cougars, wolf-dog hybrids and mute swans); and threatened or endangered species. Note: Possession of an endangered or threatened species first requires a permit obtained through the Bureau of Endangered Resources, PO Box 7921, Madison, WI 53707. A list of these species is found in ch. NR 27, Wis. Adm. Code. • A Class A CWAFL is required when a farm grosses $10,000 or more in annual sales of the species licensed. • A Class B CWAFL is allowed when a farm grosses less than $10,000 in annual sales of the species licensed. • Fee Structure: A person applying for 2 or more captive wildlife licenses that are necessary to engage in a single business or other operation shall pay a total fee that equals the fee for the license with the highest fee that is required, plus 50% of the fee for each additional required license. • The initial license fee is waived for an individual less than 14 years of age if the individual is a member of a 4-H club or a sporting club. A sporting club is a non-profit organization whose primary purpose is wildlife related outdoor recreation. Proof of membership must be enclosed with the application. • A captive wild animal farm license is effective from the date issued through the following December 31st. A CWAFL is not required: • to possess the following, provided they are not endangered or threatened species: arthropods and mollusks (Note: other licenses and restrictions apply to collection and possession of clams and crayfish), chipmunks, pocket gophers, mice, moles, opossums, pigeons, porcupines, rats, shrews, English sparrows, starlings, ground squirrels, red squirrels, voles, weasels, pheasants, non- native quail and non-native partridge. These animals must be obtained from a legal source. • to keep pheasants or other non-native game birds in pens. A bird hunting preserve license is required to use or release pheasants to hunt outside normal hunting seasons or bag limits. If game birds are used for dog training or trails outside of a bird hunting preserve, a bird dog training or trial license is required. Other Required Permits: • In addition to this license, a person may also be required to possess other local, state, or federal agency permits to possess, exhibit or transport captive wild animals. • Import permits are required from the Wisconsin Department of Agriculture Trade and Consumer Protection (DATCP) to bring animals into Wisconsin from another state or country. Record and Reporting Requirements: • License holders must submit copies of records or reports required to be kept under ch. NR 16, Wis. Adm. Code or under s. 169.36, Stats., to the department by required deadlines or upon request. • CWAFL may not be renewed when the licensee fails without good cause to submit all records required by s. 169.36, Stats., by the required deadlines or within 10 days of a request for the records. Escapes: If any bear, cougar, wolf-dog hybrid, mute swan, wolf, bobcat, lynx, coyote or fox escapes from its enclosure or fenced area, the licensee must notify the department within 24 hours of the escape. This may be done by calling the DNR Hotline at 1-800-847-9367. Captive Wild Animal Farm License Application A: Applicant Information: Leased Land If land is leased, a copy of the lease MUST accompany the application. All lease(s) shall be in writing and shall include: 1. Specific authorization of the right to establish a captive wild animal farm for the term of the captive wild animal farm license. 2. Name of the land owner(s) and lessee(s). 5. The term (length) of the lease. 3. A legal description of the land leased. 6. Identify any conditions placed on the lease. 4. Signatures of both owner(s) and lessee(s). B: Animal Species Information: Harmful Wild Animals: Bear, Cougar, Wolf-dog hybrids and Mute Swans are designated as harmful wild animals. Additional requirements exist for these species including: • Additional Species-specific Application: No CWAFL application will be approved for the possession of harmful wild animals unless the application is accompanied by the appropriate additional species-specific application. • Perimeter Fencing: In most cases, an outdoor housing facility for harmful wild animals shall be enclosed by a secondary perimeter fence that is at least 8 feet high and at least 3 feet from the primary enclosure and which restricts unauthorized humans from entering the area where the primary enclosure is located.